Hospitalization Experiences Among Nursing Home Residents With Dementia

Hospital admissions among nursing home residents with Alzheimer's disease and related dementias (ADRD) are burdensome, expensive, and provide limited clinical benefit. Compared with other patients, those with ADRD are more likely to experience adverse events when hospitalized. Our objective was to comprehensively describe the in-hospital experience of nursing home patients with ADRD.

We analyzed 1 randomly selected hospitalization per patient from the electronic health record.

Adult patients with an ADRD diagnosis from a single health system in Ohio and Florida who resided in a nursing home and were transferred to a hospital from January 2013 to July 2023.

Descriptive statistics for each variable.

Of 10,195 patients, median age was 84 years, 71% were White, 61% were female, and median length of stay was 5 days. During the hospitalization, 69% required a sitter, 34% a Foley catheter, 21% were diagnosed with delirium, and 4% died. Six percent were put in restraints, 4% experienced a fall, and 51% were administered at least 1 neuropsychiatric medication. Fewer than half of all patients (45%) had a do-not-resuscitate order, 5% had a consultation with palliative care, 2.4% with geriatrics, and 1.1% with hospice. Nearly 20% of all patients were admitted to the intensive care unit (ICU). Of these, 58% had do-not-resuscitate orders, 78% required a sitter, 53% had delirium, 17% had an order for restraints, 62% had a Foley catheter, and 10% had a long-term feeding tube inserted. Ten percent of ICU patients had a consultation with palliative care, 3.4% with geriatrics, and 2.2% with hospice.

Patients undergoing hospital admission suffered distressing experiences, but most patients did not have do-not-resuscitate orders, and referrals to hospice and palliative care were rare. Patients and their family members should be informed about the hospital experience before admission and offered appropriate care services.